The Leeds Teaching Hospitals Trust is one of the biggest NHS trusts in the country, with over 14,000 employees working across seven hospital sites.
Previous initiatives developed to reduce hospital acquired infections had been mainly remedial and concentrated on dealing with the effects of infections. The work that had been done to identify the root causes of infections was mainly clinically focused. Whilst these various initiatives had led to some reductions in infections, the levels of infection in some areas of the hospital remained amongst the highest in the country and had to be tackled urgently.
We recognised the need to do something different and the opportunity to turn some of the more traditional approaches on their head.
“This is the best hospital-based service transformation I’ve seen in the NHS in 20 years.”
Our approach was to start with a focus on the patient and hospital experience they received. In other words, rather than focusing on reducing infections, we started off thinking about what it would take to create an environment in which infections and other service failures wouldn’t be allowed to happen.
Following an intensive engagement process with staff at all levels of the organisation and patients, we concluded that the underlying causes of high infection rates probably lay in more deep-seated cultural issues surrounding staff and management attitudes towards patient safety and care. The insights gained were translated into a series of recommendations that proposed two parallel levels of activity: a ‘top-down’ shift of leadership focus and organisational culture to become more patient focused and a ‘bottom-up’ service transformation programme to address the infections challenge at the front-line.
Journey4 developed and facilitated an innovative service transformation programme called ‘Safe Hands’. This programme empowered front-line employees to help shape and deliver a positive and consistent patient experience. A series of change initiatives were proposed, by a multi-disciplinary team of front-line employees over a rolling period of 5 days, 5 weeks and 5 months.
The programme was initially piloted in the hospital wing that had the highest level of infections with Trust service improvement specialists being involved throughout and effectively trained on the job so that they could then roll the approach out across the organisation.
The number of infections on the wards in the pilot wing fell from an average of seven per month before the pilot to zero over the programme period. Even more encouragingly, when we revisited the wing 18 months after the programme was launched, there still hadn’t been any infections.
At the conclusion of the programme we formally evaluated the approach using a series of measures that employees had developed against a balanced performance dashboard. Not only had the number of infections fallen but staff morale and co-operation was 100% better; sickness and absence levels were halved over the pilot period; customer complaints fell by 75%; and employee attraction and retention significantly improved.